Washington University Prevention Epicenter

About this Epicenter

The WU/BJC Prevention Epicenter works collaboratively with CDC and other Prevention Epicenters to perform research and translate discoveries into novel strategies to prevent HAIs and AR. The WU/BJC Prevention Epicenter is widely recognized for HAI and AR research and leadership. BJC is an integrated healthcare delivery system, including 15 hospitals, long-term care facilities, and outpatient practices. BJC includes two academic hospitals, including Barnes-Jewish and St. Louis Children’s Hospitals, and 13 suburban and rural hospitals. The WU/BJC Prevention Epicenter also has a research team with expertise in infectious diseases, epidemiology, informatics, microbiology, critical care, microbiome, and metabolism to study HAI and AR in diverse settings.

This Prevention Epicenter currently uses large administrative databases (including Medicare, Medicaid, and National Inpatient Sample) to study risk factors, outcome, and prevention of HAIs in diverse settings and perform translational research to understand the epidemiology and transmission dynamics of antimicrobial-resistant infections, role of the fecal microbiome in the development and spread of antimicrobial-resistant bacteria, unique biomarkers and metabolic profiles to diagnose urinary tract infections, new strategies to improve antibiotic stewardship, and bundled interventions to prevent surgical site infections.

Accomplishments:

The overarching goal of this multicenter research team is to develop improved systems to detect and prevent HAIs and AR. This Epicenter team developed standardized reporting procedures to more efficiently collect and report risk-stratified HAI surveillance data using active surveillance, electronic medical record data, and administrative data. This data has led to improved interventions to prevent HAIs in the most vulnerable patients, including older adults, immuno-suppressed; intensive care unit (ICU) patients; patients with invasive devices, such as central venous catheters and mechanical ventilation; and surgical patients.

The WU/BJC Prevention Epicenter has also developed and implemented multidisciplinary interventions, which have dramatically reduced the rates of catheter-related bloodstream infections and ventilator-associated pneumonia in ICU patients over the past 10 years.

Core Research Study Areas

This Prevention Epicenter has a high impact 5-year research project plan with novel strategies to evaluate and predict inappropriate antibiotic use and AR regionally and nationally, reduce surgical site infections, test novel initiatives to improve outpatient antibiotic prescribing, identify metagenomic and metabolite differences between hospital and community-associated Clostridioides difficile (C. diff), and reduce AR organism reservoirs in hospitals.

Core research study areas include:

• Evaluate the use, effectiveness, and safety of antimicrobials in community-acquired pneumonia (CAP) using national administrative data
• The impact of an existing Anesthesia Control Tower (ACT) intervention to improve intraoperative care on infectious outcomes
• Stewardship initiative to limit post discharge prophylactic AU after mastectomy
• Identify fecal microbiome and metabolite markers of community-associated (CA) diff colonization and infection (CDI)
• Define the prevalence of antibiotic resistant organisms (ARO) in the hospital ICU environment andtheir relationship to ARO in clinical culture isolates and measure the impact of an environmental hygiene intervention on ARO concentration in ICU sink drains, the surrounding environment, and bioaerosols

Multicenter Collaborative Research Projects

• Novel Microbiological and Metabolomic Approaches to Detect Implant-Associated Infections in Women Post Mastectomy
• Metabolomic Differentiation to Aid in Diagnosis of C. diff infection (MD Dx CDI study)
• Clinical, Metagenomic, and Metabolomic Predictors of Infections and Asymptomatic Colonization due to Community-Associated ESBL-producing Enterobacterales (PREDICT CA-ESBL)

Principal Investigator

Victoria Fraser, MD
Co- Investigators: Hilary Babcock MD MPH, Anne Butler PhD, Gautam Dantas, PhD, Erik Dubberke MD MPH, Michael Durkin MD, Jeff Henderson MD, Kevin Hsueh MD, Jenny Kwon DO, Jonas Marschall MD, Margaret Olsen PhD, Cristina Vaquez-Guillamet MD, David Warren MD MPH.